Nicole Kelleher

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2203556 Issued in OH

Practice address

9930 Johnnycake Ridge Rd Ste 4F
Mentor, OH 44060-6762

Phone

(440) 579-5100

NPI assigned

Nov 30, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Neo Counseling Services, LLC

  • Mental Health Counselor
  • Mentor, OH
  • NPI 1528421252

  Clinical

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, OH

  Medicare reassignment NPD
• Arrowpoint Counseling LLC

  • Community/Behavioral Health Agency
  • Perry, OH
  • NPI 1124865423
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1326552183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9930 JOHNNYCAKE RIDGE RD STE 4F",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440606762",
            "telephone_number": "440-579-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9930 JOHNNYCAKE RIDGE RD STE 4F",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440606762",
            "telephone_number": "440-579-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEHER",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-30",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2203556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karl S. Stoler, O.D. & Associates, Inc.
• Jennifer Leigh Karlstrom, L.S.W.
• Andrea Kaseda
• Jillian Marie Kay, LPN
• Rebecca Keefe
• Wendy J Kelley, LISW-S
• Veronica Kelly-Lewis, BA, MS.ED. QMHS
• Thomas Patrick Kelly
• Kemper House Mentor
• Rona Kempert

• Clinical Social Worker in Mentor, OH
• Providers in Mentor, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.